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The Adversarial Nature of LTD Claims; Insurance Companies Lookout for Themselves!

Osterhout Berger Disability Law > Blog  > The Adversarial Nature of LTD Claims; Insurance Companies Lookout for Themselves!

The Adversarial Nature of LTD Claims; Insurance Companies Lookout for Themselves!

Claims for LTD benefits are adversarial cases, where the employer and/or insurance company has claims adjusters, doctors, vocational experts and other experts who provide evidence against the worker’s interest. So, even though the “HR person” at the company may be, in fact, a very nice person, this should not lull the worker into forgetting that, in the end, the employer/insurance company will always look out for itself first.

The process for applying for LTD benefits requires strict adherence to the time frames established in the Department of Labor’s regulations, and all evidence and all medical and vocational opinions should be submitted with the application, if possible. If the LTD claim is denied, the claimant has 180 days to file an appeal; this may seem like a long time, but the last chance to submit evidence is when this appeal is filed. If the claim is again denied after the appeal, the worker’s last chance is an appeal to a federal district court.

Because of the strict procedural deadlines, the need to submit evidence in a timely fashion, and the need to develop a persuasive narrative establishing that the worker is “disabled” based on the law and the evidence, it takes very careful, long term, strategic planning to anticipate the legal arguments and medical opinions that will be brought to bear against the worker. In other words, a worker who thinks they may be entitled to LTD benefits, in our opinion, needs to be guided from the very beginning by someone knowledgeable and dedicated to solving the difficulties of the disabled worker.

 

Julie Phelps